CREATIVITY AND INNOVATION IN HEALTHCARE - ACHE

CREATIVITY AND INNOVATION IN HEALTHCARE

Bernard J. Healey

CHAPTER

4

Learning Objectives

After completing this chapter, the reader should be able to

? describe the process of developing creativity and innovation in employees,

? discuss the role played by leaders in creating a climate of creativity and innovation,

? explain the differences between intrinsic motivation and extrinsic motivation, and

? summarize the process of innovation.

Key Terms and Concepts

? Continuous quality improvement ? Creativity ? Dual operating system ? Flow ? Human capital ? Innovation ? Network structure ? Reinvention ? Intrinsic motivation ? Six Sigma

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64 Healthcare Leadership

Introduction

Creativity The ability to create something new and valuable. Innovation The creation of improved products or services.

Reinvention The activity of making major changes and improvements.

To deal with the dual problems of unsustainable cost increases and poor quality of care, US healthcare organizations are attempting to reinvent the way healthcare is delivered. This is no small task, and many who work in healthcare believe it is impossible to achieve. Reinventing the healthcare delivery system is certainly the greatest challenge to confront the largest industry in the United States since World War II.

The most feasible and effective solution may be the development of creativity and innovation in every aspect of the healthcare delivery system. This type of change is difficult to effect in a bureaucratic organizational structure run by managers who may block any such shift.

Despite the fact that the healthcare industry is riddled with problems associated with cost escalation and low-quality services, an enormous amount of venture capital remains available to the many businesses and organizations that operate in this field. That availability of money, combined with an industry in the midst of disruption, is encouraging many nontraditional companies to enter a variety of sectors in the healthcare services delivery market. These companies believe they can deliver healthcare services to an increasingly knowledgeable consumer using a new business model. In response, current, traditional healthcare providers should first look at how other markets were disrupted, such as the camera, music, and book markets, to prepare their organization for disruption. At the same time, these incumbents should begin the process of reinventing their particular segment of healthcare delivery.

This type of reinvention can only become reality through the emergence of strong leadership supplemented by empowered followers who are not afraid to fail as they innovate. The healthcare leader must spend time and energy encouraging followers to think creatively and pursue innovation, as will be required to reinvent healthcare services in new and redesigned forms, reduce costs, and improve the quality of services.

Stevenson and Kaafarani (2011) argue that for creativity and innovation to bring change for the organization, the leader must understand both concepts as well as the value of each.

Creativity is the ability to look at the world, in particular its processes, services, and products, differently than others do. The authors define innovation in terms of three components: "it has to be unique, it has to be valuable, and it has to be worthy of exchange" (Stevenson and Kaafarani 2011, 9).

Furthermore, the innovation, once discovered, must be implemented. Therefore, creative people give us new ways of looking at things, and innovators implement the new ideas.

Individuals tend to be afraid of failure and see no personal value in change; thus, they are not motivated to change. In a way, staff constantly

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Chapter 4: Creativity and Innovation in Healthcare 65

calculate their own cost?benefit analysis of the activities they perform. If in a given movement they are inspired to accomplish a specific goal and the value to them seems greater than the cost, most individuals work in that direction. With that understanding, the leader must create a business environment in which creative thinking can emerge and grow. Before looking at the leader's role in the development of creativity and innovation in the organization, we discuss both concepts in more depth.

Creativity

As mentioned earlier, virtually anyone has the ability for innovative and creative thinking (Dyer, Gregersen, and Christensen 2011). To elicit that type of thinking in healthcare today, workers must be empowered to use their creativity to find innovative ways to deliver quality services while reducing the enormous waste occuring in the healthcare delivery system. The leader needs to spend time listening to followers and customers to find out what goes wrong and then discover how to fix the problems as a team.

The Misfit Economy

Clay and Phillips (2015) refer to the presence of a distinct group of misfits in the US economy who are capable of creativity. These individuals have the ability to perform what others may see as miracles in identifying new processes or products and bringing them to fruition. According to Clay and Phillips, these misfits are driven by the opportunity to win their self-designed war with those who have been in the market for a substantial period--an example of intrinsic motivation (discussed later in the chapter)--and are set up to succeed because of an informality mind-set that allows them to avoid the constraints of rules and regulations.

Much insight may be gained from an analysis of how misfits obtain success in existing markets. The misfit mentality frees individuals to think differently. These are the type of entrepreneurs needed to redesign healthcare delivery.

Concepts in Organizational Creativity

Creativity is all around us, as are creative people who advocate radical, or simply different, ideas or ways of viewing activities, opportunities, obstacles, products, and so on. To think creatively is to use one's imagination to discover deficiencies or gaps in current knowledge. The creative individual is usually defined as someone who can expand her thinking by ignoring rules and regulations in her quest to envision a different future. The end of the creative process typically entails the development of something new and

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66 Healthcare Leadership

Flow A mental state in which work is enjoyable, challenging, and ultimately productive.

Intrinsic motivation Impetus to act found within the individual and driven by internal rewards.

valuable. Creativity in employees has become mandatory for any organization facing the many challenges that healthcare continues to confront in the twenty-first century.

According to Florida and Goodnight (2005), creative employees accomplish the greatest results when they are challenged during the process of work. Creativity can be stimulated by the leader who serves as a role model of creativity for his staff. In addition, all employees must listen to customers and make them part of the creative process.

Csikszentmihaly (2009) points to the development of flow in employees' work, which triggers an enjoyable feeling when their work is challenging and the related activities require focus and concentration. Notably, this period of flow also involves a struggle to solve a challenging problem, with individuals expending much energy simply because it is a challenge.

The concept of flow at work is an important revelation for leaders in healthcare organizations because it represents a way to engage employees that is necessary to meet the challenges facing the industry. Csikszentmihaly (2009) points out that the optimal human experience can occur when one's consciousness is characterized as in order. This state can only occur when energy and attention are focused on goals that are realistic and achievable. The leader's responsibility, then, is to help followers achieve their flow, which should ultimately improve healthcare delivery while satisfying the needs of his followers.

To do so, however, the leader must understand and appreciate the importance of flow and its complementary state, intrinsic motivation. Such motivation arises from within, as seen with misfit creatives. Money and status are not always the greatest--and certainly not the only--motivators for healthcare employees. Intrinsic motivation is often the very reason healthcare staff come to work every day. The question becomes how to supply intrinsic motivation to healthcare employees who are undergoing massive change in the way they do their work. The answer is to involve all the employees in the change process from the beginning. The leader needs to tap their expertise in the redesign of the healthcare system where they do their work. The process of change in healthcare is discussed in more detail in chapter 8.

Jim Goodnight, cofounder and CEO of SAS Institute in Cary, North Carolina, has learned how to unleash the creativity of all his company's stakeholders. His research and implementation of certain policies have resulted in unprecedented creativity success or flow among SAS employees. He credits his success to the following three principles:

? Keep employees actively engaged by removing distractions. ? Make managers responsible for instilling creativity in employees. ? Engage the customer as a partner in creativity.

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Chapter 4: Creativity and Innovation in Healthcare 67

Leaders at SAS bring their employees together to facilitate the exchange of ideas and then work to turn the new ideas into innovations. The most important factor is the frequency with which they interact meaningfully with their customers to secure their ideas of how to create better software. SAS refers to this procedure as managing creative capital.

As demonstrated by SAS, stimulating creativity is not necessarily difficult. It does involve empowering employees to view situations, processes, or products in new lights and bringing them together to exchange ideas toward innovation.

Importantly, an idea that is not acted on remains as a thought only. It may even be thought of as a waste of mental energy.

Creativity in Healthcare: Geisinger Health System

Geisinger Health System, located in central and northeastern Pennsylvania, has been an example of innovative care and payment models for years (Paulus, Davis, and Steele 2008). Geisinger is structured as an open yet integrated delivery system, a type of structure that allows for collaboration. Creativity at Geisinger is fostered through a highly collaborative style of work that incorporates multiple approaches to innovation, including continuous quality improvement, Six Sigma, and Lean reengineering. Examples of innovations pursued by the Geisinger system are presented in the following paragraphs.

Personal Health Navigator Program Geisinger's Personal Health Navigator (PHN) program is a patient-centered medical home designed to provide value for patients through care coordination. Innovators at Geisinger created the concept from an existing process with the goal of ensuring the availability of primary and specialty care 24 hours a day, seven days a week to Geisinger patients. Patients are assigned a dedicated health navigator, who attempts to empower patients to learn more about their health issues and how to navigate the healthcare system and then make educated decisions about appropriate health services. This relatively new health initiative was seen as a way to transition a patient from expensive episodic healthcare to a primary care approach. The PHN, designed to target the elderly Medicare population, was launched in 2006 and has focused on disease management and preventive care (Maeng et al. 2015). This program has achieved savings in total healthcare costs and reduced acute inpatient care. Maeng and colleagues (2015) attribute their success to improved data, enhanced leadership focused on the entire care process, and improved quality of care.

In addition, the program resulted in enhanced patient satisfaction and care accessibility, reduced hospitalization rates, increased use of home-based health monitoring, and improved focus on the proactive management of

Continuous quality improvement An approach to quality in which managers and workers continually strive for improved performance.

Six Sigma A data-driven approach to eliminating defects that sets as a standard no more than six errors per 1 million opportunities (the statistical threshold of 6).

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